Abdominal aortic laparoscopic surgery: Retroperitoneal or transperitoneal approach?

Abstract

Objective: to define the respective advantages and pitfalls of the trans- or retroperitoneal approaches in laparoscopic abdominal aortic reconstruction (LAOR). Design: prospective study. Material: ten patients (8 males; average age 58) underwent an aortouni- (n = 2) or bifemoral bypass (n = 8) to treat aortoiliac occlusive disease (n = 8) or an aortic aneurysm (n = 2). Methods: a retroperitoneal approach (the 'apron' technique) was used in the first 5 cases (Group I) and a transperitoneal approach in the last 5 cases (Group II). Results: no early or late death occurred, and all bypasses remain patent after a mean follow-up of 5.7 months. Mean surgical and clamping times are similar in both groups (370 and 126 min in Group 1; 324 and 137 min in Group II). One intraoperative conversion to open surgery and two postoperative surgical complications occurred in Group I. Four minilaparotomies of 8-10 cm were necessary in Group II. Two patients were discharged on postoperative day 6 in Group I and five in Group II. Conclusion: this preliminary study shows the feasibility of LAOR through both approaches. In Group II, a better exposure of the right aortic wall and of the right iliac axis was noted and division of the inferior mesenteric artery was not always necessary.